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Abstract

Thirteen Cambodian refugees who had survived 2-4 years of concentration camp experience met the DSM-III criteria for posttraumatic stress disorder. Their predominant symptoms were avoidance, hyperactive startle reactions, emotional numbness, intrusive thoughts, and nightmares, which had lasted at least 3 years after the imprisonment. The patients’ avoidance of thoughts or discussion of the past and the shame they felt about Cambodia’s history made diagnosis and treatment difficult. These findings give cross-cultural validation to the diagnosis of posttraumatic stress disorder and should alert clinicians to its existence in a population not previously studied. (Am J Psychiatry 141:645-650, 1984) O n the basis of his studies of the concentration camp syndrome in Danes confined to a German camp during World Wan II, Eitingen (1) believed that posttnaumatic stress syndrome is organic and is caused by trauma and malnutrition. Others (2, 3) have blamed the massive, prolonged psychological trauma in concentration camps: separation from and loss of relatives, frequent arbitrary executions, forced labor, deprivation of food and shelter, and constant fear of death. They felt that the resultant syndrome was outside normal experience and triggered a persistent reaction in many people. In a follow-up study (4), concentration camp experience was found to have long-term effects even on individuals who appeared to have adjusted well. Remarkably consistent symptoms, including chronic depression, anxiety, sleep disorders, fatigue, recurring nightmares, isolation, rumination, irritability, and a hyperactive startle reaction, were present in almost all camp survivors. In a study of combat and prisoner of war (POW) experiences (5), the subjects had similar major symp-